PbR Data Assurance Framework

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PbR Data Assurance Framework

• Key Messages

PbR Data Assurance Team Health
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PbR Data Assurance Framework

• What is it?
• What did we find out?
• What should you do?
• Whats coming next?

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The assurance framework

• A rolling programme of external audits covering
  inpatients and outpatients
• Providing assurance of the accuracy (or not) of
  coding and therefore payments made to providers
• Driving improvements in data quality and clinical
  coding arrangements
• National analysis to identify significant trends
  and share good practice
• Development of online benchmarking function to
  support PCTs trusts

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PbR assurance 2008/09

• Continuation of clinical coding audit programme
  at all acute trusts (follow up on
  recommendations)
• Reviews of outpatient data quality at
  approximately a third of trusts
• Piloting of reviews covering the independent
  sector
• Further development and refinement of the
  national benchmarker
• Research into key areas from 2007/08

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Lessons learnt
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Findings and recommendations
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HRG errors (2007/08)
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HRG errors (Qs 1-3 2008/09)
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Individual trust change
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Individual trust comparison
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Gross financial error (2007/08)
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Net financial error (2007/08)
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Net financial error (Qs 1-3 2008/09)
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Coding errors (Qs 1-3 2008/09)
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Key themes local action
Source Audit Commission PbR Data Assurance
Framework 2007/08
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Key themes national action
Source Audit Commission PbR Data Assurance
Framework 2007/08
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Key themes Commission action
Source Audit Commission PbR Data Assurance
Framework 2007/08
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PbR assurance the road ahead
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PbR assurance next year (2009/10)

• 2009/10 (yr3) continuation of programme
• Allows broader understanding of data quality and
  each trust
• Key changes in PbR
• HRG4 -- new tariff -- OPCS 4.5 -- MFF -- SUS
• Piloting AE audits
• Reference costs

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Impact on HRG4

• Sense check analysis
• Compared impact under HRGv3.5 HRG4
• Error rate slightly higher under HRG4
• Overall financial impact still relatively neutral
• Volatility for individual trusts and specialities
• Local action required to understand impact

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Risk based approach

• 2010/11 (yr4) move to risk based approach
• Consulting with NHS in the summer
• Proportionate approach
• Do more at less trusts
• Integrate all audits
• More data items
• Wider scope

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PbR National Benchmarker
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PbR National Benchmarker tool

• Powerful online tool freely available to the NHS
• Developed as part of the assurance framework
• Robust and sophisticated benchmarking
  methodology
• 42 separate indicators covering both inpatient
  and outpatient data
• Focus on data quality but relevance beyond PbR

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Data explorer
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Scorecard viewer
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HRG4 benchmarking

• PbR National Benchmarker updated with HRG4
  benchmarking May 2008
• Developed in conjunction with NHS Information
  Centre
• New HRG4-specific indicators, including
• Unbundling
• Planned same day
• Short stay elective
• Improved functionality

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So what should you do?

• Identify areas for improvement
• Review findings from audits
• Implement action plans
• Understand your data
• Ratify data with SUS
• PbR National Benchmarker
• Understand impact of HRG4 and new tariff

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For more information

• www.audit-commission.gov.uk/pbr